Provider Demographics
NPI:1215733829
Name:ROOSEVELET PT PC
Entity type:Organization
Organization Name:ROOSEVELET PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:
Authorized Official - First Name:AMRO
Authorized Official - Middle Name:
Authorized Official - Last Name:BARAKAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-318-3148
Mailing Address - Street 1:121 WINHAM AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-4930
Mailing Address - Country:US
Mailing Address - Phone:631-318-3148
Mailing Address - Fax:
Practice Address - Street 1:591 W MERRICK RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5119
Practice Address - Country:US
Practice Address - Phone:516-206-0100
Practice Address - Fax:516-206-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center